03-12-2014 | Predicting post-neurosurgery seizure outcomes

03 December 2014
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Brain scans could be used as a means of predicting seizure outcomes in epilepsy patients, according to a new study.

Carried out by Pennsylvania State University, the study aimed to test the hypothesis that computed tomography (CT) volumetric analysis can be used in patient selection to help predict outcomes following resection.

For this study, a total of ten paediatric patients received preoperative CT scans and temporal resections at the CURE Children's Hospital of Uganda, with classifications of seizure control levels determined 12 months postoperatively. Temporal lobe volumes were measured from CT and normative MR images, with whole brain and fluid volumes also assessed using particle filter segmentation.

Linear discrimination analysis was also performed to classify seizure outcome by temporal lobe volumes and normalised brain volume, with the results appearing in the Journal of Neurosurgery: Pediatrics.

It was shown that the volume of each temporal lobe could be used to separate patients who were seizure-free from those with incomplete seizure control. Additionally, the authors found that age-normalised whole brain volume, in combination with temporal lobe volumes, may further improve outcome prediction.

The researchers concluded there is strong evidence that "temporal lobe and brain volume can be predictive of seizure outcome following temporal lobe resection, and that volumetric CT analysis of the temporal lobe may be feasible in lieu of structural MRI when the latter is unavailable".

They added: "Since the authors' methods are modality-independent, these findings suggest that temporal lobe and normative brain volumes may further be useful in the selection of patients for temporal lobe resection when structural MRI is available."

It is hoped that this new technique could be particularly useful in developing nations, where access to structural MRI is often limited.

The availability of better predictive tools could also help to improve acceptance of epilepsy surgery as a viable option for those who do not respond to antiepileptic drugs – around 30 per cent of all patients.

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